Zoledronic Acid (Zometa)

Covered: Zometa is allowed for hypercalcemia of malignancy (single dose, retreat ≥7 days if Ca not normalized), for multiple myeloma and bone metastases from solid tumors when given with standard antineoplastic therapy, and for specified compendial uses (breast/prostate SRE prevention, osteoporosis prevention/treatment in men on ADT, fracture-risk reduction in postmenopausal breast cancer patients); use is not recommended in severe renal impairment and doses >4 mg are excluded. Key requirements: documentation of relevant labs (albumin‑corrected Ca ≥12 mg/dL for hypercalcemia; serum Ca above lab LLN), correction of hypocalcemia and calcium/vitamin D supplementation, baseline and pre‑dose renal monitoring (no severe renal impairment), specific clinical criteria (breast bone mets ≥3 months expected survival; castration‑recurrent prostate disease; BMD/FRAX thresholds for osteoporosis), dosing/renal limits, required documentation, and a 12‑month approval duration.